Is Alcoholism an Allergy?
Is Alcoholism an Allergy?
If you have spent any time in an AA meeting, you have heard someone say it, and you have probably heard someone push back on it.
Alcoholism is an allergy.
The pushback usually sounds something like this:
"That isn't what an allergy is. An allergy is an immune reaction. Alcoholism isn't that. The medical community abandoned that idea decades ago."
And here is the thing: by the modern medical definition of allergy, that objection is correct. Alcoholism is not classified as an allergic reaction today.
But that does not settle the question of what Dr. William Silkworth meant when he used the word.
Because Silkworth was not writing today.
He was writing in the 1930s, using a medical word whose meaning was still being developed, debated, and defined by physicians themselves.
The modern definition did not yet exist in its present form.
So before we decide that Silkworth used the word incorrectly — and throw out the Doctor's Opinion with it — there is a more rigorous question to ask:
What did "allergy" mean when he used it?
WHERE THE WORD CAME FROM
"Allergy" is younger than most people realize.
The word did not exist before the twentieth century.
It was coined on July 24, 1906, by the Viennese pediatrician Clemens von Pirquet in a short article titled "Allergie." He built the word from two Greek roots: allos, meaning other, and ergon, meaning action.
The basic idea was altered reactivity.
Von Pirquet had been observing changes in the way patients reacted after exposure to vaccines and serum treatments. His concept was broader than the meaning we give the word today. It could include an increased response, a decreased response, a protective response, or a harmful response.
"Allergy" had not yet become the narrowly defined medical category we now recognize.
That matters.
Because when we open the Big Book thirty-three years after 1906, Dr. Silkworth is describing a particular group of people whose bodies appear to respond to alcohol differently from the bodies of ordinary drinkers.
Not everybody who drinks too much.
Not every hard drinker.
A particular class of drinker.
Under von Pirquet's original concept, that description already had a home: an altered reactivity — a harmful response that shows up in some bodies and not others.
THE WORD WAS STILL BEING DEFINED
By the 1930s, "allergy" had become common medical language.
But its meaning was anything but settled.
In 1935, JAMA — the Journal of the American Medical Association, one of the most widely read medical journals in the world — published a discussion of the definition of allergic diseases and complained about the widespread loose use of the word. Physicians were actively debating how broadly or narrowly "allergy" should be defined.
Some wanted the word restricted to specific forms of demonstrable hypersensitivity.
Others were still using it more broadly for unusual reactions occurring in certain people but not in most people exposed to the same substance.
That's how Silkworth used it.
Some researchers were so dissatisfied with the confusion surrounding the word that they proposed replacing it altogether.
Think about what that means.
When Silkworth used the word allergy, there was no single modern definition sitting in a medical textbook for him either to follow or violate.
The boundaries of the word were still being worked out.
So Silkworth was not a physician carelessly borrowing a word that obviously meant something entirely different.
He was participating in a medical conversation that was happening in his own time.
The word did not suddenly change after Silkworth. It was still evolving — and he was writing in the middle of that evolution.
WHAT SILKWORTH WROTE IN THE BIG BOOK
Silkworth uses the word twice in the Doctor's Opinion.
First:
"We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all."
And later, describing drinkers who are entirely normal in every respect except in the effect alcohol has on them:
"They cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence."
An abnormal reaction. Limited to one class of people. Never occurring in the ordinary drinker. No cure. Abstinence as the only remedy.
He watched that pattern repeat through thousands of patients, and he named it with a medical word his own era recognized, even as the term itself was still being formalized.
SO WHEN DID THE WORD GET ITS MODERN MEANING?
The modern mechanism-based classification of allergic reactions did not arrive until 1963. The antibody behind classic allergies — IgE (immunoglobulin E), the one that drives hay fever, peanut reactions, and hives — was not identified until 1966.
And the definition in use today dates to 2004, when the World Allergy Organization formally restricted "allergy" to reactions driven by specific immune mechanisms. Even that paper calls itself a revision of an earlier one — and says the terms may need further updating as knowledge advances.
That was sixty-five years after the Big Book went to print.
Silkworth did not misuse a settled medical term. The profession has been defining the word from 1906 to the present day — and their own paper says the terms may still need revising. He wrote in the middle of the argument.
Medicine explains what he saw differently now. But the reaction he watched in all those patients never went away.
And that is why the word still works in our rooms.
As Silkworth used it, describing a physical reaction unlike what most bodies experience when they drink, the word "allergy" simply makes sense. It matches what happened to us. Alcohol sets off something in our bodies that does not happen in other people's. The person who does not experience it cannot understand it. There is no better way to explain it.
THE RECEIPT IS IN THE BOOK ITSELF
The word allergy is important. But not as important as what it stands for — a real physical reaction, described by a doctor who knew exactly what he was looking at.
When someone decides the allergy language is outdated, they very often decide the whole Doctor's Opinion is obsolete — and then the First Step goes with it. They throw out the pages that describe their own drinking.
But here is the remarkable part.
The Big Book already answered this objection. It answered it in 1939, inside the Doctor's Opinion itself — in the founders' own words, printed between the doctor's two statements:
"The doctor's theory that we have an allergy to alcohol interests us."
Theory.
The founders never claimed medicine had proven an allergy. They presented a doctor's explanation, called it exactly what it was, and asked one question of it: does this illuminate what we have lived through?
The terminology belongs to its time. The book never asks us to defend it.
The experience described in the book belongs to the people who recognize themselves in it.
We don't want to throw out the chapter that describes our own drinking because a definition adopted in 2004 does not match a word chosen in the 1930s. The word "allergy" worked — and we liked it. And the word "theory" was sitting inside that chapter the whole time, for anyone who didn't.
Dr. Silkworth used a recognized medical concept of his own decade to describe something he had watched thousands of times.
And alcoholics understood it. They could see it. Feel it.
"It explains many things for which we cannot otherwise account."
Call it an altered reactivity. Call it a theory. Or simply an allergy.
What it describes hasn't moved an inch.
For us, once we start drinking, everything changes. The phenomenon of craving takes over — that same phenomenon Dr. Silkworth watched in patient after patient and suggested was the manifestation of an allergy.
The most important question is not "Is alcoholism an allergy?"
It's the one The Doctor's Opinion has been asking since 1939:
Are you one of the people he is describing?
SOURCES
C. von Pirquet, "Allergie," Munchener Medizinische Wochenschrift, vol. 53 (July 24, 1906), pp. 1457-58. The original essay in which the word is coined.
"Definition of Allergic Diseases," Journal of the American Medical Association (1935). The medical profession debating the word's boundaries in Silkworth's own decade: https://jamanetwork.com/journals/jama/article-abstract/259820
J. M. Igea, "The history of the idea of allergy," Allergy (2013). A full history of the term published in the flagship journal of allergy medicine — the 1906 coinage, the contested decades, and proposals to abandon the word entirely. Open access: https://onlinelibrary.wiley.com/doi/full/10.1111/all.12174
Mark Jackson, Allergy: The History of a Modern Malady (Reaktion Books, 2006). A book-length history tracing how the meaning of the word drifted ever further from its creator's original intention. Review: https://pmc.ncbi.nlm.nih.gov/articles/PMC1894880/
W. D. Silkworth, "Alcoholism as a Manifestation of Allergy," Medical Record (March 17, 1937). The doctor's own paper, published two years before the Big Book. For further study — the original pages, digitized by the National Library of Medicine: https://collections.nlm.nih.gov/ext/mm/2934112RX321/PDF/2934112RX321.pdf
P. G. H. Gell and R. R. A. Coombs, classification of hypersensitivity reactions (1963); K. Ishizaka and T. Ishizaka, identification of IgE (1966). The science that made a mechanism-based definition possible.
Johansson et al., "Revised nomenclature for allergy for global use," Journal of Allergy and Clinical Immunology (2004). The official nomenclature that formally restricted "allergy" to immune-mediated reactions: https://www.jacionline.org/article/S0091-6749(04)00930-3/fulltext
Alcoholics Anonymous, "The Doctor's Opinion," p. xxii.